Isaac Yang, Won Kim, Antonio De Salles and Marvin Bergsneider
Stereotactic radiosurgery (SRS) has emerged as an adjuvant radiation-based therapy for pituitary adenomas. Here, the authors present a systematic analysis of SRS for growth hormone–secreting adenomas to characterize the efficacy of SRS in the treatment of acromegaly.
A comprehensive search of the English language literature revealed 970 patients with new, recurrent, or persistent acromegaly that had been treated using SRS along with assessable and quantifiable outcome data. Articles published between June 1998 and September 2009 were included in the analysis. Patient outcome data were aggregated and investigated based on tumor size, radiosurgery dose, and clinical outcomes both with and without medication.
The overall disease control rate without medication was 48%–53%, and the overall disease control rate with or without medication was 73%. The overall mean duration of the reported follow-up was 48.5 ± 25.8 months. The mean overall tumor volume in this analysis was 2.11 ± 1.16 cm3. The Pearson product-moment correlation coefficient for tumor volume and cure rate was not significant (r = 0.0668, p = 0.8546).
Data from this analysis suggest that tumor size may not be a significant prognostic factor in disease control after radiosurgery for acromegaly. The overall disease control rate was approximately 48% without suppressive medications after radiosurgery for acromegaly. With the advancement of increasingly sophisticated stereotactic planning and tumor targeting, the precision of radiosurgery may continue to improve in the treatment of acromegaly.
Ching-Jen Chen, Cheng-Chia Lee, Hideyuki Kano, Kathryn N. Kearns, Dale Ding, Shih-Wei Tzeng, Ahmet Atik, Krishna Joshi, Gene H. Barnett, Paul P. Huang, Douglas Kondziolka, David Mathieu, Christian Iorio-Morin, Inga S. Grills, Thomas J. Quinn, Zaid A. Siddiqui, Kim Marvin, Caleb Feliciano, Andrew Faramand, L. Dade Lunsford and Jason P. Sheehan
Contrary to the better described obliteration- and hemorrhage-related data after stereotactic radiosurgery (SRS) of brain arteriovenous malformations (AVMs) in pediatric patients, estimates of the rarer complications, including cyst and tumor formation, are limited in the literature. The aim of the present study was to assess the long-term outcomes and risks of SRS for AVMs in pediatric patients (age < 18 years).
The authors retrospectively analyzed the International Radiosurgery Research Foundation pediatric AVM database for the years 1987 to 2018. AVM obliteration, post-SRS hemorrhage, cyst formation, and tumor formation were assessed. Cumulative probabilities, adjusted for the competing risk of death, were calculated.
The study cohort comprised 539 pediatric AVM patients (mean follow-up 85.8 months). AVM obliteration was observed in 64.3% of patients, with cumulative probabilities of 63.6% (95% CI 58.8%–68.0%), 77.1% (95% CI 72.1%–81.3%), and 88.1% (95% CI 82.5%–92.0%) over 5, 10, and 15 years, respectively. Post-SRS hemorrhage was observed in 8.4% of patients, with cumulative probabilities of 4.9% (95% CI 3.1%–7.2%), 9.7% (95% CI 6.4%–13.7%), and 14.5% (95% CI 9.5%–20.5%) over 5, 10, and 15 years, respectively. Cyst formation was observed in 2.1% of patients, with cumulative probabilities of 5.5% (95% CI 2.3%–10.7%) and 6.9% (95% CI 3.1%–12.9%) over 10 and 15 years, respectively. Meningiomas were observed in 2 patients (0.4%) at 10 and 12 years after SRS, with a cumulative probability of 3.1% (95% CI 0.6%–9.7%) over 15 years.
AVM obliteration can be expected after SRS in the majority of the pediatric population, with a relatively low risk of hemorrhage during the latency period. Cyst and benign tumor formation after SRS can be observed in 7% and 3% of patients over 15 years, respectively. Longitudinal surveillance for delayed neoplasia is prudent despite its low incidence.